0:00:02 > 0:00:06This programme contains some strong language
0:00:06 > 0:00:07Emergencies.
0:00:10 > 0:00:12Bad behaviour.
0:00:13 > 0:00:14Bedside battles.
0:00:14 > 0:00:16Alfie, Alfie, Alfie, Alfie!
0:00:16 > 0:00:19And buckets of blood.
0:00:19 > 0:00:22It's a tough job being a doctor.
0:00:22 > 0:00:25It's even tougher when you're young...
0:00:26 > 0:00:29Am I right or not? I feel like a child, because in their eyes,
0:00:29 > 0:00:31I think you probably are.
0:00:31 > 0:00:32I don't want to scare you.
0:00:32 > 0:00:34..untried...
0:00:34 > 0:00:35It's my second day.
0:00:35 > 0:00:38- The first time any of us do anything, we're going to be- BLEEP.
0:00:38 > 0:00:40..and inexperienced.
0:00:40 > 0:00:43- 'Everyone's in the same boat.' - Push it through, twiddle, twiddle.
0:00:43 > 0:00:45No-one knows what they're doing.
0:00:45 > 0:00:48But after years of studying...
0:00:48 > 0:00:49Oh, dear!
0:00:49 > 0:00:54..it's time to put theory into practice on medicine's front line.
0:00:54 > 0:00:56# What a feeling
0:00:56 > 0:00:57# To let it all go... #
0:00:57 > 0:01:01- Yeah!- For the past three months, eight junior doctors have been
0:01:01 > 0:01:04living and working together in London.
0:01:04 > 0:01:05Wow!
0:01:05 > 0:01:07Ben and Amieth.
0:01:07 > 0:01:10- Aki, Andy and Lucy. - Any more for any more?
0:01:10 > 0:01:16Milla, Sameer and Priya are coming to the end of their current jobs.
0:01:16 > 0:01:22I'd make a pretty amazing, hotshot, competent, secretary.
0:01:22 > 0:01:25The junior doctors will soon be moving to new departments
0:01:25 > 0:01:27as part of their ongoing training.
0:01:27 > 0:01:30'Sometimes, I feel like a doctor, when I just get on with it.
0:01:30 > 0:01:32And then, sometimes, you're a bit like,
0:01:32 > 0:01:35"Right, I'm not quite sure what's going on here."
0:01:35 > 0:01:37You know, it feels a bit like being a student again.
0:01:37 > 0:01:41Now in the final weeks of their placements...
0:01:41 > 0:01:43Thank you for being so nice to me!
0:01:43 > 0:01:45PAGER BEEPS
0:01:45 > 0:01:47..they'll need to stand on their own two feet.
0:01:47 > 0:01:50- A patient has fainted. - You could commit suicide?
0:01:50 > 0:01:53I don't know how to do it. It's a situation that I've never been in.
0:01:53 > 0:01:56Prove they can tackle more than just the basics.
0:01:56 > 0:02:00Good afternoon, my name's Ben Allin. It's like a kick in the nuts.
0:02:00 > 0:02:02Can we get some fluid? Get some oxygen as well.
0:02:02 > 0:02:05And finally feel like doctors.
0:02:05 > 0:02:08It takes a few hours for the fluid to drain.
0:02:08 > 0:02:12I can't stick a needle into his chest without his consent.
0:02:12 > 0:02:14That's assault, and I could go to jail for something like that.
0:02:26 > 0:02:30The junior doctors are entering the final stage
0:02:30 > 0:02:33of their current jobs on the wards.
0:02:33 > 0:02:36- Oh, your first night's tonight? - Yeah.- Are you excited?- I'm scared.
0:02:36 > 0:02:37You'll be fine.
0:02:37 > 0:02:41Andy is about to start his first set of night shifts.
0:02:41 > 0:02:44- I didn't realise you were starting nights tonight.- I know.
0:02:44 > 0:02:46Don't worry. They're not all bad.
0:02:46 > 0:02:51You learn quite a lot, which is more satisfying than just another day.
0:02:51 > 0:02:54It'll be nice to feel like I'm doing a bit more medicine,
0:02:54 > 0:02:57- but clearly with that comes stress. - You'll be all right. You'll feel better when they're out of the way.
0:02:57 > 0:03:01- So all of today, I've been absolutely- BLEEP- it about nights.
0:03:01 > 0:03:05I think the scary thing about nights is you just, yeah, are much less supported.
0:03:05 > 0:03:08It sounds like you've got to step up a bit,
0:03:08 > 0:03:12so it's sort of like a last big test, really.
0:03:19 > 0:03:23Andy has been working in General Surgery for the past three months.
0:03:23 > 0:03:27Now, as part of the night team, he'll be on the front line
0:03:27 > 0:03:30for any surgical emergencies across the whole hospital.
0:03:30 > 0:03:31Hi.
0:03:33 > 0:03:37I feel scared, that's what I feel like. Oh, well. Let's just go for it!
0:03:37 > 0:03:40For first year, Andy, adjusting to life as a doctor
0:03:40 > 0:03:42has been a steep learning curve.
0:03:42 > 0:03:44PAGER BLEEPS
0:03:48 > 0:03:52He's struggled to meet his own high expectations.
0:03:52 > 0:03:55And now, Andy's got to overcome his biggest hurdle.
0:03:55 > 0:03:58After I've done that first set of nights,
0:03:58 > 0:04:01I might feel more ready to be, "Yeah, I'm a doctor."
0:04:01 > 0:04:03Right, let's just run through this list.
0:04:03 > 0:04:06I'm going to go in and see this lady...
0:04:06 > 0:04:09On the night shift, Andy's getting a handover from his team.
0:04:09 > 0:04:10See you soon.
0:04:16 > 0:04:18My SHO, he was like,
0:04:18 > 0:04:21"We're going to get a bit of sleep and then you can run the show."
0:04:21 > 0:04:24So I was just a bit like, "Oh, God!"
0:04:24 > 0:04:30It was going pretty well until now, now that's been said.
0:04:30 > 0:04:33So yeah, just hope that it'll be quiet.
0:04:33 > 0:04:39# Who's gonna save the world toni-i-i-ight? #
0:04:39 > 0:04:43- Andy's called to an urgent case. - So tell me what's been going on then.
0:04:43 > 0:04:46Um, at five o'clock today, this cramp started.
0:04:46 > 0:04:49If I move or if I cough or if I laugh or anything like that,
0:04:49 > 0:04:53- then it really hurts. - Point to me exactly where.
0:04:53 > 0:04:56The middle, just here. Underneath the belly button, round here.
0:04:56 > 0:04:58I need to have a feel of your tummy now.
0:04:58 > 0:05:0122-year-old Christabel has severe abdominal pains.
0:05:01 > 0:05:03Ow!
0:05:03 > 0:05:06- Ow!- That's painful there, is it? I think you should come into hospital.
0:05:06 > 0:05:09You seem to be in a lot of pain. Something might be going on.
0:05:09 > 0:05:13It could be appendicitis, it could be something ovarian, potentially.
0:05:13 > 0:05:16- Just want to make sure.- Thank you. - Brilliant. See you soon.
0:05:16 > 0:05:18Eh, some x-rays, maybe an ultrasound...
0:05:18 > 0:05:22Andy wastes no time and immediately orders further investigations.
0:05:22 > 0:05:26I've got a patient in A&E I've just requested some x-rays for.
0:05:26 > 0:05:29All right, cheers, thank you. Bye-bye.
0:05:29 > 0:05:33It's really quite different to being on days, because I'm seeing patients.
0:05:33 > 0:05:35It's actually awesome! It's not going to be awesome when
0:05:35 > 0:05:39I start getting more and more patients through, I'm sure.
0:05:39 > 0:05:43It's 5.30am. Nine hours into Andy's shift.
0:05:43 > 0:05:45So far, it's been a quiet night.
0:05:45 > 0:05:48If you look straight ahead for me. PAGER BLEEPS
0:05:48 > 0:05:51But then, an emergency.
0:05:51 > 0:05:54It's his patient, Christabel.
0:05:54 > 0:05:57The patient I saw earlier has fainted.
0:05:57 > 0:06:02Her abdominal pains have taken a turn for the worse.
0:06:02 > 0:06:03Hi.
0:06:03 > 0:06:06Hi, had a faint, didn't you?
0:06:06 > 0:06:09He's the first doctor on the scene and needs to take charge.
0:06:09 > 0:06:12Can we get fluids in, please? Can we get some gelofusine?
0:06:12 > 0:06:15Get some oxygen as well, please. All right.
0:06:15 > 0:06:18So we're just going to give you a bit of oxygen and some fluids.
0:06:18 > 0:06:21And it'll help you feel a bit better, all right?
0:06:21 > 0:06:24OK. No, what's been going on with your chest?
0:06:30 > 0:06:31OK.
0:06:31 > 0:06:33Can we get an ECG as well? Thanks.
0:06:37 > 0:06:41After stabilising Christabel with fluids,
0:06:41 > 0:06:43Andy calls his senior for back up.
0:06:43 > 0:06:46She's had a faint and her blood pressure's dropped.
0:06:46 > 0:06:47She's looking very pale.
0:06:47 > 0:06:51I just thought I'd call you sooner rather than later about this,
0:06:51 > 0:06:53cos I think she looks quite unwell.
0:06:53 > 0:06:58I think she might have bled from somewhere, actually.
0:06:58 > 0:07:00Heart rate's 45.
0:07:00 > 0:07:02BP's lower than before. Thank you.
0:07:02 > 0:07:04All right, see you soon. Bye-bye.
0:07:04 > 0:07:08If Andy's right and it's internal bleeding,
0:07:08 > 0:07:09it could be fatal.
0:07:09 > 0:07:12'She's obviously in quite a bad way. Really, really pale.
0:07:12 > 0:07:16'She just looked like someone that had lost quite a lot of blood.'
0:07:16 > 0:07:19We thought at first it could be an appendix or an ovarian problem.
0:07:19 > 0:07:23Think it's more likely to be an ovarian or gynaecological problem.
0:07:23 > 0:07:24Possibly a bleed from a cyst.
0:07:26 > 0:07:27OK.
0:07:27 > 0:07:31A specialist team now takes over her care.
0:07:32 > 0:07:35Yeah, so that was pretty scary, actually.
0:07:35 > 0:07:38This night's been quite a bit of a rollercoaster really,
0:07:38 > 0:07:40a bit weird, like.
0:07:40 > 0:07:42An hour of sitting around and literally nothing to do,
0:07:42 > 0:07:44and then you get a bleep
0:07:44 > 0:07:47and someone looks like they're on the verge of dying. It's crazy.
0:07:47 > 0:07:50But, um, it's pretty good to be honest.
0:07:50 > 0:07:55I'd rather do that than do really boring paperwork jobs all day.
0:07:55 > 0:07:56Like, this is just awesome.
0:07:58 > 0:08:01The night shift over, it's been the biggest challenge
0:08:01 > 0:08:03Andy's ever had to face.
0:08:03 > 0:08:05It's just quite reassuring, really,
0:08:05 > 0:08:07that I don't lose it in a situation like that.
0:08:07 > 0:08:10It's nice to do some stuff like this, do some emergency stuff,
0:08:10 > 0:08:14where you actually sort of make a bit of a difference.
0:08:14 > 0:08:17Yeah, it feels like you're doing proper doctor stuff.
0:08:17 > 0:08:20Andy's made it through the night, but for the other doctors,
0:08:20 > 0:08:24it's the start of a new day.
0:08:24 > 0:08:26Bye!
0:08:27 > 0:08:29Look at you go!
0:08:29 > 0:08:33At the hospital, the general medical ward has been first year Lucy's base
0:08:33 > 0:08:36for the past three months.
0:08:36 > 0:08:39She's been treating elderly patients who have a range of illnesses.
0:08:39 > 0:08:43Are you the new doctor everybody's excited about?
0:08:43 > 0:08:45- I don't think so. - Are you?- That won't be me!
0:08:45 > 0:08:49She has impressed with her great bedside manner and caring attitude.
0:08:49 > 0:08:53You're looking a bit brighter. Are you feeling a bit better?
0:08:53 > 0:08:56At times, perfectionist Lucy has found it difficult to achieve
0:08:56 > 0:08:58her own high standards.
0:08:58 > 0:09:00It's just complete BLEEP, basically.
0:09:02 > 0:09:05You're 97 and doing everything on your own. Can't complain!
0:09:05 > 0:09:07I shall be 100 soon!
0:09:07 > 0:09:11Suspected stroke victim, Rosemary, is Lucy's next patient.
0:09:11 > 0:09:13Isn't it a miserable crowd?
0:09:13 > 0:09:15Every time you've been in a hospital, if you wave to them,
0:09:15 > 0:09:19they don't wave back. They don't smile.
0:09:19 > 0:09:22- The miserable buggers! - You need to spruce them up!
0:09:22 > 0:09:27She'd been living independently until she was rushed into hospital.
0:09:27 > 0:09:31- Right.- If a happy person comes, will you send them along this way?
0:09:31 > 0:09:34- Of course I will! - Goodbye.- Nice to see you.
0:09:34 > 0:09:38- 'Really lovely lady, 97.' - Oh, she's lovely!
0:09:38 > 0:09:40I think she's had a stroke while she was in a bath.
0:09:40 > 0:09:42- Yeah.- Couldn't get out.
0:09:42 > 0:09:45We're treating her for a UTI, her antibiotics are due to finish today.
0:09:45 > 0:09:47She's medically very well.
0:09:47 > 0:09:49It's just about getting her home safely.
0:09:49 > 0:09:52- Rosemary is well enough to leave hospital.- Hello!
0:09:52 > 0:09:55But Lucy is still worried about her patient.
0:09:55 > 0:09:57I wonder whether I'll be able to manage when I get home?
0:09:57 > 0:10:01Well, that's exactly why I want to talk to you.
0:10:01 > 0:10:03You see, I haven't got anybody to help.
0:10:03 > 0:10:07Only one niece, and she's got three children.
0:10:07 > 0:10:12I'm just a burden to you relations. Oh, I don't know.
0:10:12 > 0:10:15You could commit suicide, couldn't you? That would be easy!
0:10:15 > 0:10:18- That would NOT be easy! - I've often thought about it.
0:10:18 > 0:10:20I'm concerned with somebody that's SO well,
0:10:20 > 0:10:23and had such an interesting life, that you're getting
0:10:23 > 0:10:27to the point that you think that you want to see yourself off.
0:10:27 > 0:10:29I don't want to send you home
0:10:29 > 0:10:34and you be thinking that you're going to go and do something to yourself.
0:10:34 > 0:10:37When somebody is so blunt about the fact that
0:10:37 > 0:10:39they feel like a burden on people,
0:10:39 > 0:10:41and actually, that feeling is so strong
0:10:41 > 0:10:44it makes them think that they don't want to live any more,
0:10:44 > 0:10:48when somebody says that you, it's quite, it's quite shocking.
0:10:48 > 0:10:54And I certainly feel quite responsible.
0:10:54 > 0:10:58I want to have a situation where you're going to feel happy when you get back,
0:10:58 > 0:11:01and you don't feel like you're a burden to people,
0:11:01 > 0:11:05and that you can live normally, and enjoy yourself.
0:11:05 > 0:11:08It's one thing to learn about facts from a book,
0:11:08 > 0:11:11or to learn how to examine a patient, or interpret blood tests.
0:11:11 > 0:11:15But then when you're faced with a REAL person
0:11:15 > 0:11:18and the consequences of getting something wrong,
0:11:18 > 0:11:19that's really very hard,
0:11:19 > 0:11:22and it comes as one of the many things in medicine,
0:11:22 > 0:11:24that come with experience.
0:11:26 > 0:11:29As a junior doctor with limited experience,
0:11:29 > 0:11:33finding a solution for this new challenge won't be easy.
0:11:33 > 0:11:36I think we could maybe get a bit of help at home for you.
0:11:36 > 0:11:40That's what I don't like, I don't want people to bother...
0:11:40 > 0:11:42People do this for a job, so you're not burdening them.
0:11:42 > 0:11:45I can't help but think that if we get home and get used to the idea,
0:11:45 > 0:11:48to accept help, she could flourish again.
0:11:48 > 0:11:51I don't know how to do it, it's a difficult one,
0:11:51 > 0:11:53it's a situation I've never been in before.
0:11:58 > 0:12:02Back at home, Lucy can't get her job off her mind.
0:12:02 > 0:12:04- All right, Lucy? - Long-time no see, Andy Pandy.
0:12:04 > 0:12:08- Indeed. - How were nights, did you survive?
0:12:08 > 0:12:11- Awesome, I had a really good time. - They're not bad.- What about you?
0:12:11 > 0:12:15But, God, it's just, it's quite hard work at the moment.
0:12:15 > 0:12:18It's just, you know.
0:12:18 > 0:12:21Do you ever feel that you get a bit too emotionally attached?
0:12:21 > 0:12:26Or start to worry too much when your patients have left hospital and stuff?
0:12:26 > 0:12:29No, I don't think I've become emotionally attached,
0:12:29 > 0:12:31you just hope that they're doing OK.
0:12:33 > 0:12:36And they put their trust in you, don't they?
0:12:36 > 0:12:40I feel like I owe them something, really.
0:12:44 > 0:12:46- Hello.- Hi.
0:12:46 > 0:12:48You deciding what kind of takeaway to get, are you?
0:12:48 > 0:12:51It's been a long day and I'm being lazy.
0:12:51 > 0:12:55Have an Indian takeaway, with curry and naan and poppadoms and chutney.
0:12:55 > 0:12:58- The housemates are settling in for the night.- See you later, guys.
0:12:58 > 0:13:03But Andy is heading to work, back on the nightshift.
0:13:06 > 0:13:09- All right, how's it going? - Good, how are you?
0:13:09 > 0:13:10Good, yeah.
0:13:10 > 0:13:13His first priority is to find out what's happened
0:13:13 > 0:13:16to his emergency patient, Christabel.
0:13:16 > 0:13:19Has she, like, had surgery or anything?
0:13:24 > 0:13:25Oh, my God!
0:13:25 > 0:13:27This is actually the first really, like,
0:13:27 > 0:13:30really seriously ill person I've had to deal with.
0:13:30 > 0:13:33Christabel's scans show that Andy's suspicions
0:13:33 > 0:13:37of a bleeding ovarian cyst were right.
0:13:37 > 0:13:40All around the outside, that's the blood.
0:13:40 > 0:13:44And you can see all the organs being compressed by a load of blood.
0:13:44 > 0:13:47And there's a cyst from the ovary
0:13:47 > 0:13:49which is probably what she's bled from.
0:13:49 > 0:13:54This is probably the first time I've had to deal with something that was really serious,
0:13:54 > 0:13:57and it's nice to know that I was doing the right thing.
0:13:57 > 0:14:01You know, it felt good, actually, yeah.
0:14:04 > 0:14:07- Hi, how you feeling?- Um, better. - Brilliant.
0:14:07 > 0:14:10When I saw you last I was worried, you looked pretty ill.
0:14:10 > 0:14:12So, home soon?
0:14:12 > 0:14:14Um, yeah, I think Mum is taking me home,
0:14:14 > 0:14:16back to the countryside to recuperate.
0:14:16 > 0:14:19But the doctors told me
0:14:19 > 0:14:22I can't really have much partying or anything for three weeks.
0:14:22 > 0:14:24Probably a good idea, considering what you've been through.
0:14:24 > 0:14:28Nice to meet you anyway. Yeah, hope everything goes well.
0:14:28 > 0:14:30- Thanks so much, Andrew. - Best of luck with everything.
0:14:30 > 0:14:33- Thank you. - All right, see you soon, bye.
0:14:33 > 0:14:38I just remember him running around a lot and looking quite sweaty,
0:14:38 > 0:14:43because I felt he was really MY doctor, kind of thing, and looking after me.
0:14:43 > 0:14:46Like all junior doctors,
0:14:46 > 0:14:49the nightshift is providing Andy with valuable experience.
0:14:49 > 0:14:54It certainly takes away, you know, some of the monotony of the daytime
0:14:54 > 0:14:57when you're literally just doing paperwork.
0:14:57 > 0:15:00This is just, you know, you are only seeing the sick patients.
0:15:00 > 0:15:03And yeah, it's what being a doctor is about, really,
0:15:03 > 0:15:06or what people do it for. So, it's given me a bit more passion
0:15:06 > 0:15:09to go forward and carry on, really, definitely.
0:15:12 > 0:15:14Three floors down in A&E.
0:15:14 > 0:15:17Put in just a few more stitches to hold the wound together.
0:15:17 > 0:15:21Amieth is also hoping to build on his experience as a junior doctor.
0:15:21 > 0:15:24So, I understand that you had some problems with your lungs
0:15:24 > 0:15:26and your breathing, is that right?
0:15:26 > 0:15:29Can I have a listen to your chest, then.
0:15:29 > 0:15:32As a second-year doctor at the end of his placement,
0:15:32 > 0:15:35Amieth needs to show his bosses that he's progressed to the next level,
0:15:35 > 0:15:37advanced procedures.
0:15:37 > 0:15:42His latest patient has serious breathing problems.
0:15:42 > 0:15:46So, this increase in symptoms is over the last few days?
0:15:46 > 0:15:49All right. Are you a former smoker or a smoker?
0:15:49 > 0:15:51Never smoked in your life.
0:15:51 > 0:15:53Yeah.
0:15:53 > 0:15:55Pretty big.
0:15:55 > 0:15:58He's got a large amount of fluid in the right side of the chest,
0:15:58 > 0:16:03compressing the right lung. The right lung should be here,
0:16:03 > 0:16:06but all of this white stuff here is fluid.
0:16:06 > 0:16:10Removing that should hopefully help with his symptoms of breathlessness.
0:16:10 > 0:16:15But treating patients in A&E has been a big adjustment for Amieth.
0:16:17 > 0:16:19At the sharp end of acute medicine,
0:16:19 > 0:16:23he's had to deal with everything from heart failure to head wounds.
0:16:23 > 0:16:25I think it might be sensible to get the scan first.
0:16:25 > 0:16:27I think we should stitch first.
0:16:27 > 0:16:31Now, he needs to prove that he can treat more complex cases on his own,
0:16:31 > 0:16:33like fluid around the lungs.
0:16:33 > 0:16:36You've had some fluid in the chest in the past?
0:16:36 > 0:16:40And when was the last time you came in and had a drain?
0:16:50 > 0:16:53Yeah, will probably take some of the fluid from the lungs
0:16:53 > 0:16:55just to see under the microscope what it is.
0:16:55 > 0:16:57If we're sticking a drain in,
0:16:57 > 0:17:00then that's actually putting the tube into the chest
0:17:00 > 0:17:02and attaching it to an underwater seal
0:17:02 > 0:17:04so that the fluid can drain out.
0:17:04 > 0:17:07Aki did one, I think, in his first week,
0:17:07 > 0:17:10he's been bragging about it ever since.
0:17:10 > 0:17:13A chest drain is an invasive procedure,
0:17:13 > 0:17:16that will slowly drain the fluid overnight.
0:17:16 > 0:17:19We're going to clean the skin, then put in a tube
0:17:19 > 0:17:21to try and train some of fluid from the lung.
0:17:25 > 0:17:28It takes a few hours for the fluid to drain.
0:17:28 > 0:17:31The patient is refusing treatment.
0:17:31 > 0:17:33For personal reasons he needs to get home,
0:17:33 > 0:17:36and can't stay in hospital overnight.
0:17:36 > 0:17:39Amieth tries to get the patient to understand
0:17:39 > 0:17:42that without a chest drain his breathing problems could get worse
0:17:42 > 0:17:44and become life-threatening.
0:17:44 > 0:17:48It's really important to not force treatments to patients,
0:17:48 > 0:17:50even if we think that they're for the best.
0:17:50 > 0:17:53I can't stick a needle into his chest without his consent.
0:17:53 > 0:17:56That's assault, and I could go to jail for something like that,
0:17:56 > 0:18:00in theory, and it's not nice to do things to a patient
0:18:00 > 0:18:04- that they don't want. - His senior, Jamie, has to intervene.
0:18:07 > 0:18:10He's not very happy to stay overnight,
0:18:10 > 0:18:12but last time he had it aspirated,
0:18:12 > 0:18:15and that was a painful procedure, and he doesn't like that either.
0:18:15 > 0:18:18What we need to know is that you will actually agree to this,
0:18:18 > 0:18:21because we don't want to bully you into this, all right?
0:18:21 > 0:18:24The reason for doing it is to get this fluid off,
0:18:24 > 0:18:26to help you to breathe a bit better.
0:18:26 > 0:18:28Hand on heart, would you want us to do this
0:18:28 > 0:18:30or do you want us to not do this?
0:18:34 > 0:18:36You want us not to do this?
0:18:36 > 0:18:39It's incredibly difficult for a junior doctor to deal with,
0:18:39 > 0:18:43as soon as a patient withdraws consent you have to stop what you're doing.
0:18:43 > 0:18:46There's no way to know how far to push it,
0:18:46 > 0:18:48that's something that you learn with time,
0:18:48 > 0:18:50and you often will have to pull in someone more senior
0:18:50 > 0:18:52to help you out in those situations.
0:18:53 > 0:18:56We have got to get that fluid out.
0:18:56 > 0:18:59It's not the outcome Amieth had hoped for.
0:18:59 > 0:19:03And in general medicine, Lucy is also encountering problems.
0:19:03 > 0:19:08Rosemary, we're seeing you know. Hello, come on, we're seeing you now.
0:19:08 > 0:19:13She's struggling to find a solution for Rosemary, it's serious,
0:19:13 > 0:19:15having contemplated suicide,
0:19:15 > 0:19:19Rosemary's also refusing to accept help at home.
0:19:19 > 0:19:22I'm a very private person, I don't want people to keep on...
0:19:22 > 0:19:23Pestering you?
0:19:23 > 0:19:27I did have one, "What can I do now? Did I get that right?"
0:19:27 > 0:19:31- Did it annoy you?- You understand, I don't know what to do.
0:19:31 > 0:19:35- I completely understand what your saying.- I'm useless.
0:19:36 > 0:19:39But Lucy's not giving up.
0:19:39 > 0:19:43Hello, David Erskine? Is this Rosemary Clement's niece?
0:19:43 > 0:19:47Hello, I'm one of the doctors that's caring for her at the moment.
0:19:47 > 0:19:50She speaks to Rosemary's closest relative to discuss options.
0:19:50 > 0:19:52I'm pleased I've spoken to you.
0:19:52 > 0:19:55With cases like Rosemary's there's not an easy answer,
0:19:55 > 0:19:57and there's not a right answer.
0:19:57 > 0:20:00Because there's loads of options, I think you've just got to get,
0:20:00 > 0:20:02get what seems to be the best possible solution.
0:20:04 > 0:20:08Lucy has arranged for Rosemary's niece to come in for a meeting.
0:20:08 > 0:20:10She doesn't want anyone coming to her house
0:20:10 > 0:20:12because she doesn't want to be a burden.
0:20:12 > 0:20:15But she doesn't want to accept help from people that it's their job.
0:20:15 > 0:20:18Social Services and the mental health team have also been invited.
0:20:26 > 0:20:31They all agree, the best solution is to get some extra help at home.
0:20:31 > 0:20:34The decision has come to discharge her home
0:20:34 > 0:20:38and live as she was doing before, but to introduce a little bit of care.
0:20:38 > 0:20:40It's probably an arrangement they'll play by ear.
0:20:40 > 0:20:43Her family is supportive as well.
0:20:43 > 0:20:47Rosemary's niece was able to convince her aunt that
0:20:47 > 0:20:50getting some extra help at home wouldn't be a burden on anyone.
0:20:50 > 0:20:52Hello. Just me.
0:20:52 > 0:20:57- My niece was arranging something with some charity person.- She did.
0:20:57 > 0:20:59You are happy with that?
0:20:59 > 0:21:00- Yes.- I'm pleased.
0:21:00 > 0:21:03I think Lucy copes really well with Rosemary's case.
0:21:03 > 0:21:05She has great communication skills,
0:21:05 > 0:21:10she spoke to her niece, she liaised well with all the other teams.
0:21:10 > 0:21:11She did a really good job.
0:21:11 > 0:21:16- I feel I can manage.- That's good. I am pleased you feel you can manage.
0:21:16 > 0:21:21It's a breakthrough for Lucy, but back in A&E, progress is slow.
0:21:21 > 0:21:26Only one night. It won't be a long time - one night.
0:21:29 > 0:21:35Desperate to get home, Amieth's patient is still refusing
0:21:35 > 0:21:37to stay overnight for a chest drain.
0:21:37 > 0:21:40I have done it in the past with a green cannula
0:21:40 > 0:21:43and a three-way tap syringe.
0:21:43 > 0:21:46If we say, we will take out what we can
0:21:46 > 0:21:50and keep you for a couple of hours and send you back, regardless.
0:21:51 > 0:21:53Is that what you want?
0:21:53 > 0:21:59- There was a three-way tap in the box. - Finally, a deal is struck.
0:21:59 > 0:22:01The only alternative is a more painful
0:22:01 > 0:22:05but faster procedure that will allow him to get home tonight,
0:22:05 > 0:22:08but he's only giving Amieth one hour.
0:22:08 > 0:22:11Cold cleaning on your back, OK?
0:22:11 > 0:22:14Amieth gets the chance to perform this tricky procedure.
0:22:14 > 0:22:19He sticks a three-inch needle into the space around the patient's lungs and syringes out the fluid.
0:22:19 > 0:22:21Sharp scratch.
0:22:23 > 0:22:25That's it. It's coming out now.
0:22:35 > 0:22:37The procedure is a success
0:22:37 > 0:22:41and Amieth beat the deadline, taking just 40 minutes.
0:22:41 > 0:22:44Due to Amieth's very strong wrist action,
0:22:44 > 0:22:46he managed to pull off about 1,600mls of fluid
0:22:46 > 0:22:50just using a needle and syringe.
0:22:50 > 0:22:53Would we have allowed him to do it three months ago? Probably not.
0:22:53 > 0:22:56We try to let people step into it. He has built up to this.
0:22:56 > 0:23:01There were some jealous second years who were keen to take his place.
0:23:02 > 0:23:04Just taking my pleural fluid for a walk.
0:23:06 > 0:23:09- We have 1,400.- It's a good amount of fluid to get out.
0:23:09 > 0:23:12Hopefully, it will help.
0:23:12 > 0:23:16He sat in the corridor singing It Is A Long Way To Tipperary.
0:23:16 > 0:23:21I think the registrars and seniors will be quite happy that
0:23:21 > 0:23:23I showed I knew what I was doing.
0:23:23 > 0:23:28The registrar walked off and let me get on with aspirating the fluid.
0:23:28 > 0:23:33It's a busy department and they had other things to do.
0:23:33 > 0:23:38Next time, obviously, they'll be happier I can do it on my own.
0:23:38 > 0:23:41If there is a next time.
0:23:41 > 0:23:45I felt quite comfortable, confident in what I was doing
0:23:45 > 0:23:47and I knew we would be successful.
0:23:54 > 0:23:56For the past three months,
0:23:56 > 0:24:00Ben has been working with children in a paediatric surgery.
0:24:00 > 0:24:02Now in his second year,
0:24:02 > 0:24:05Ben has to choose the area he wants to specialise in,
0:24:05 > 0:24:08and he's set his sights on paediatric surgery.
0:24:08 > 0:24:11I find working with kids incredibly rewarding.
0:24:11 > 0:24:13Just seeing what the surgeons there do,
0:24:13 > 0:24:15seeing the operations they perform.
0:24:15 > 0:24:19You can make a huge difference with something that you're able to do,
0:24:19 > 0:24:22and like I say, that's something I want to be part of.
0:24:22 > 0:24:25Ben needs to line up a job for his third year,
0:24:25 > 0:24:27but paediatric surgery
0:24:27 > 0:24:30is one of the most competitive areas to break into,
0:24:30 > 0:24:36and trying to make his mark in this skilled specialty hasn't been easy.
0:24:36 > 0:24:38I can't do it!
0:24:38 > 0:24:40Alfie, Alfie.
0:24:40 > 0:24:43- He got off to a rocky start. - Sorry.
0:24:43 > 0:24:46Basics that he'd mastered on adults in his first year...
0:24:46 > 0:24:48You're not giving us any more, are you?
0:24:48 > 0:24:50..were a struggle on children.
0:24:50 > 0:24:54It's a nightmare getting blood from teeny, teeny little babies!
0:24:55 > 0:24:57It's 11 weeks since he started,
0:24:57 > 0:25:00and Ben's about take blood from baby Kemi.
0:25:00 > 0:25:04Probably best if we get you holding her,
0:25:04 > 0:25:07with her legs wrapped around you, and then one arm poking out,
0:25:07 > 0:25:09so she can't see what we're going to do.
0:25:09 > 0:25:12Paediatrics, you're helping a child.
0:25:12 > 0:25:15A lot of the kids associate you with pain, and the fact that
0:25:15 > 0:25:19you'll be putting needles in, doing operations and causing them pain,
0:25:19 > 0:25:21and they're too young to know you're helping.
0:25:21 > 0:25:23Aww. All clean!
0:25:24 > 0:25:26Kemi was born four months premature,
0:25:26 > 0:25:29and has been in and out of hospital ever since.
0:25:29 > 0:25:32Having had 30 operations in her short life,
0:25:32 > 0:25:34her veins have been used so many times
0:25:34 > 0:25:38that finding a healthy one to take blood isn't easy.
0:25:38 > 0:25:41BABY CRIES
0:25:45 > 0:25:49Ben's got it on his first attempt.
0:25:49 > 0:25:51Sorry!
0:25:51 > 0:25:55- There we are, all done. That was easier than expected!- Yep.
0:25:55 > 0:25:58- All built up for it to be a nightmare.- Yeah, I know!
0:25:58 > 0:26:00He's making progress.
0:26:00 > 0:26:02I'm sorry!
0:26:02 > 0:26:09But if Ben wants to clinch his dream job in the competitive field of paediatrics, he needs to stand out.
0:26:09 > 0:26:13Yeah. I didn't know, I just put it on there because I didn't know
0:26:13 > 0:26:15if you had a Chelsea and Westminster one that you use.
0:26:15 > 0:26:20He's volunteered to present the results of some research for his boss, Simon Clarke,
0:26:20 > 0:26:23one of the most respected paediatric surgeons in the UK.
0:26:23 > 0:26:27There is an audience of 100 plus surgeons from around Europe.
0:26:27 > 0:26:34It's always a bit nerve-wracking, the first time, but the most important thing about doing a presentation
0:26:34 > 0:26:39is simplicity, and make sure your audience doesn't fall asleep.
0:26:39 > 0:26:40Yeah.
0:26:40 > 0:26:43It's going to be good for your future career.
0:26:43 > 0:26:47Getting involved in some form of academic work is pretty important.
0:26:47 > 0:26:49There's a lot of people applying for very few posts,
0:26:49 > 0:26:54and there aren't many paediatric surgeons in the UK.
0:26:54 > 0:26:56It's a very, very small specialty.
0:26:56 > 0:27:01Ben will have to present it at a conference of senior paediatricians from across Europe.
0:27:01 > 0:27:05It is daunting. I've never failed at anything so far.
0:27:05 > 0:27:09I don't intend to start now. I was always lucky at university.
0:27:09 > 0:27:13I kept up a reasonable social life, I did well in my exams,
0:27:13 > 0:27:16I got good marks I was always happy with.
0:27:16 > 0:27:19I guess failing would be a bit of a kick in the nuts.
0:27:19 > 0:27:24Ben is taking on the biggest challenge of his career so far.
0:27:26 > 0:27:30Like Ben, Andy also has high hopes for the future.
0:27:30 > 0:27:32He wants to be a surgeon.
0:27:32 > 0:27:35Huge. I want a smaller one!
0:27:35 > 0:27:39Energised by his stint on nights, he's back on the day shift.
0:27:41 > 0:27:44Doing the nights was really invigorating.
0:27:44 > 0:27:48I'm a bit more confident with things that crop up on the wards.
0:27:48 > 0:27:50It means I can deal with them a bit quicker,
0:27:50 > 0:27:54which then allows me to hopefully get to surgery.
0:27:54 > 0:27:58To be a surgeon, Andy needs to get as much experience as he can.
0:27:58 > 0:28:01Hi, nice to meet you. My name's Andy.
0:28:01 > 0:28:03I'm one of the doctors from the surgical team.
0:28:03 > 0:28:0844-year-old Angela is having a gastric bypass to help her lose weight.
0:28:09 > 0:28:12Today you're having a gastrectomy converted into a bypass.
0:28:12 > 0:28:15- Is that right?- Yeah.- Brilliant, OK.
0:28:15 > 0:28:17Any other medical problems with your health at all?
0:28:17 > 0:28:19I'm diabetic, and I've got high blood pressure.
0:28:19 > 0:28:24- Is that type 2 diabetes?- Yeah.- Yeah. - It's diet-managed, though.
0:28:24 > 0:28:28Diet-managed, OK. I need to just have a listen to your heart and your lungs, if that's all right.
0:28:28 > 0:28:31Nice, big breaths in and out through your mouth.
0:28:32 > 0:28:35A gastric bypass is basically where you reroute
0:28:35 > 0:28:39the top of the stomach and connect it to the small intestine,
0:28:39 > 0:28:41bypassing the stomach, that's why it's called bypass.
0:28:41 > 0:28:45So you basically have a smaller, a much smaller or almost non-existent stomach,
0:28:45 > 0:28:50so you feel less hungry, you eat less food, and obviously lose weight.
0:28:50 > 0:28:53It's a technically challenging operation,
0:28:53 > 0:28:56and Andy's desperate to see how it's done.
0:28:56 > 0:28:59All ready to go, finished prep clerking a little bit late,
0:28:59 > 0:29:02but it just happens. That's medicine!
0:29:02 > 0:29:06Try to get there as soon as possible, really.
0:29:06 > 0:29:09Ready, guys?
0:29:12 > 0:29:14Hi, Mr Bonanomi. How are you?
0:29:14 > 0:29:17Andy's mentor, Mr Bonanomi, is the lead surgeon.
0:29:17 > 0:29:23To reward his hard work, he offers Andy a golden opportunity to assist.
0:29:23 > 0:29:26The first step is to watch and hold the camera.
0:29:26 > 0:29:28OK? And progressively, then, you can assist
0:29:28 > 0:29:31with the surgery and go step-by-step.
0:29:31 > 0:29:35OK, brilliant, sounds good.
0:29:35 > 0:29:37This is Andy's chance to show his potential.
0:29:37 > 0:29:39Yeah, should be good fun.
0:29:42 > 0:29:46It's complex keyhole surgery.
0:29:46 > 0:29:50Using a tiny camera to guide the way, Mr Bonanomi will connect
0:29:50 > 0:29:53the top of the patient's stomach to the small intestines,
0:29:53 > 0:29:55and Andy's job is to hold the camera.
0:30:10 > 0:30:11It's a crucial role.
0:30:11 > 0:30:16He needs to focus the camera so Mr Bonanomi can see what he's doing.
0:30:18 > 0:30:20But it's not easy for a rookie surgeon.
0:30:41 > 0:30:43Andy soon gets the hang of it.
0:30:46 > 0:30:47Scissors, please.
0:30:51 > 0:30:56He's done well, and Mr Bonanomi now asks him to stitch up the incisions.
0:30:56 > 0:31:00- Andy, you carry on like this, and at the end, you make a knot. OK?- OK.
0:31:00 > 0:31:03- OK, well done.- Sounds good, cheers.
0:31:03 > 0:31:08Andy has helped for the first time on a gastric bypass surgery,
0:31:08 > 0:31:12and I must say that he was quite confident, he did well,
0:31:12 > 0:31:18and I'm very happy about how he performed,
0:31:18 > 0:31:21and I think it should have been a nice experience for him.
0:31:21 > 0:31:23- Good, that's it.- OK?- Yep.- Cool.
0:31:23 > 0:31:26It felt great to be doing some surgery.
0:31:26 > 0:31:29I was really happy. I got to do the camera work.
0:31:29 > 0:31:35I was like his eyes, really, which was one of the hardest things ever.
0:31:35 > 0:31:37Well, I thought it was!
0:31:37 > 0:31:40It was like playing a computer game, or something.
0:31:40 > 0:31:43The operation is a success all round.
0:31:48 > 0:31:49Stop it, will you?!
0:31:51 > 0:31:52- Hello, there.- Hi.
0:31:52 > 0:31:56- Hi, Angela. How are you doing? - I'm all right, thanks.
0:31:56 > 0:31:58Did you actually do part of the operation on her?
0:31:58 > 0:32:00I wasn't actually doing anything.
0:32:00 > 0:32:04I was holding the camera for Mr Bonanomi and his registrar to see.
0:32:04 > 0:32:06That's got to be scary stuff.
0:32:06 > 0:32:08It's amazing, watching it being done, actually.
0:32:08 > 0:32:12The skill the surgeons have at doing it is something else.
0:32:12 > 0:32:16- Not a time for shaky hands, is it? - No, it's not, certainly, yeah!
0:32:16 > 0:32:18- OK, best of luck with everything.- Yeah.
0:32:18 > 0:32:19Hope it all goes well.
0:32:19 > 0:32:22- I'll probably see you in the next few days, anyway.- OK.
0:32:22 > 0:32:25- Nice to see you, as well. - Brilliant, thank you very much.
0:32:25 > 0:32:26Nice to meet you both. I'll see you all soon.
0:32:26 > 0:32:29- Wish you every success in your career.- Thanks very much.- Good luck.
0:32:29 > 0:32:32If you're interested in surgery,
0:32:32 > 0:32:36then it's certainly a huge bonus to get to go in and get involved, if that's what you want to do.
0:32:36 > 0:32:38And it's not for everyone, but for me,
0:32:38 > 0:32:41it reminds me what you're working towards,
0:32:41 > 0:32:44because that's the sort of thing that's really good fun.
0:32:45 > 0:32:47A success for Andy.
0:32:47 > 0:32:52Hi there. Can I add on a test to a blood sent, please?
0:32:52 > 0:32:57Fellow housemate Aki is also hoping to leave the Acute Assessment Unit on a high.
0:32:57 > 0:33:00There's a tender spot on the inside of that.
0:33:00 > 0:33:03Critical cases from A&E get sent here.
0:33:03 > 0:33:06It's high-pressure, with a rapid patient turnover,
0:33:06 > 0:33:09and one of the most challenging wards for a junior doctor.
0:33:11 > 0:33:13I think my confidence has grown,
0:33:13 > 0:33:17but not to the level at which I like it to be.
0:33:17 > 0:33:19I think that will come with time.
0:33:19 > 0:33:25Aki's job is to come up with the correct diagnosis for the patients under his care.
0:33:25 > 0:33:26You came in with chest pain?
0:33:26 > 0:33:28Mm-hmm. Went to bed with a niggling pain.
0:33:28 > 0:33:32Woke up, felt the same, then I was driving
0:33:32 > 0:33:35from about half seven onwards,
0:33:35 > 0:33:37and it just steadily got worse and worse.
0:33:37 > 0:33:41- Can you point to where the pain was? - Just there.
0:33:42 > 0:33:4852-year-old security van driver Dave has been sent up from A&E with a suspected heart attack.
0:33:48 > 0:33:50It felt as if someone had taken my lungs out,
0:33:50 > 0:33:54given them a good kicking, and put them back in.
0:33:54 > 0:33:56OK. Have you been abroad recently?
0:33:56 > 0:33:58- Yes, I came back from Cuba two weeks ago.- OK.
0:33:58 > 0:34:01I'm just going to lower this a little. That's fine.
0:34:01 > 0:34:03- You look quite red. Is that normal? - Sunburn.
0:34:03 > 0:34:06- Oh, sunburn, from Cuba.- Yes. - All right.
0:34:06 > 0:34:09- I thought it was a tan, actually(!) - OK, sorry. That's what I meant!
0:34:11 > 0:34:14But mastering the science of diagnosing patients
0:34:14 > 0:34:16hasn't come easily to Aki.
0:34:18 > 0:34:21- He's not always impressed his seniors.- Umm.
0:34:24 > 0:34:27And he's had gaps in his medical knowledge.
0:34:27 > 0:34:31I don't want to make mistakes. A mistake can be catastrophic.
0:34:31 > 0:34:33Open your mouth for me.
0:34:33 > 0:34:35Now coming to the end of his placement,
0:34:35 > 0:34:39Aki needs to show his bosses he can make the right diagnosis.
0:34:41 > 0:34:43Right, I'm just going to lower this a little bit.
0:34:45 > 0:34:48Aki does an ECG to check the patient's heart rhythm,
0:34:48 > 0:34:50and more tests to investigate further.
0:34:51 > 0:34:56Looking at his ECGs, and looking at this chest X-ray,
0:34:56 > 0:34:58and after examining him,
0:34:58 > 0:35:03I have a suspicion that he might actually have a chest infection.
0:35:03 > 0:35:08That might be causing the pain instead of anything coming from the heart.
0:35:09 > 0:35:11Aki's diagnosis of a chest infection
0:35:11 > 0:35:16is different to A&E's original suspicions of a heart attack.
0:35:16 > 0:35:20- I'll be back with my boss about your plan.- Good news.
0:35:21 > 0:35:23Are you free, like a bird?
0:35:23 > 0:35:27He needs to present his findings to his senior as quickly as possible.
0:35:27 > 0:35:33I couldn't see any ischaemia, or any signs of infarction.
0:35:33 > 0:35:35Any abnormalities?
0:35:35 > 0:35:40- In the ECGs?- Yep. Axis?- It's deviated to the left.- Yes.
0:35:40 > 0:35:45- Chest X-ray.- There's increased shadowing on both bases.
0:35:45 > 0:35:50- I thought maybe worse on the right. - What about the size of his heart?
0:35:50 > 0:35:53It's AP erect, so I can't really comment,
0:35:53 > 0:35:55- but it does look quite large.- Yep. OK.
0:35:55 > 0:35:58Because his white cells were raised,
0:35:58 > 0:36:01I thought it could have been some kind of pneumonia, maybe.
0:36:01 > 0:36:06- Could be.- He did go to Cuba, and it has been two weeks.
0:36:06 > 0:36:09I was thinking maybe atypical pneumonia.
0:36:09 > 0:36:10Aki's ruled out a heart attack.
0:36:12 > 0:36:16It's not a diagnosis any doctor wants to get wrong.
0:36:16 > 0:36:20My name is Suzie Pomfret. I'm one of the registrars that's on.
0:36:20 > 0:36:24Aki's been telling me a bit about what's been happening with this pain.
0:36:26 > 0:36:29His senior does the same examination as Aki.
0:36:32 > 0:36:34You've got some shadowing on your X-ray,
0:36:34 > 0:36:38and your bloods show that you've got an infection on board,
0:36:38 > 0:36:41so we were going to treat you for pneumonia.
0:36:41 > 0:36:45OK? We're going to give you some oral tablets for pneumonia.
0:36:45 > 0:36:49- Any questions?- Erm, no. None at all. - You sure?- Yeah.
0:36:49 > 0:36:52- OK, I'll see you a bit later. - OK, thanks very much.
0:36:55 > 0:36:56Aki has got the diagnosis right,
0:36:56 > 0:37:00and they can begin to treat the patient for pneumonia.
0:37:00 > 0:37:04- You treated him perfectly well. - Thank you very much.
0:37:04 > 0:37:07Good. I think that went well.
0:37:09 > 0:37:12It is really nice to hear praise,
0:37:12 > 0:37:14and it's really nice to get encouragement.
0:37:14 > 0:37:16One of my seniors did once say
0:37:16 > 0:37:20"You need to hold onto all the small victories and build from it."
0:37:20 > 0:37:22- Good night.- Thanks very much, Aki.
0:37:22 > 0:37:25- It's my absolute pleasure! - THEY LAUGH
0:37:27 > 0:37:31Seriously, eight o'clock this week has been the highlight of my life.
0:37:31 > 0:37:35- Really?- Absolutely.- Because you get to see Kate and I?- That's right.
0:37:35 > 0:37:39He's doing really well. There's the people that will go the extra mile in life,
0:37:39 > 0:37:43and you have the people that care just that little bit more,
0:37:43 > 0:37:45and you can see that Aki's one of those.
0:37:45 > 0:37:49The clerkings I've seen have been really good and, I'd say,
0:37:49 > 0:37:53on the higher end of the average house officer clerking
0:37:53 > 0:37:57that I've seen in my experience to date as a doctor.
0:37:57 > 0:38:00- Take care. Thanks for everything. - If you could check her bloods.
0:38:00 > 0:38:02I promise you, I'll check her bloods.
0:38:02 > 0:38:05- Thank you very much. Good night.- Well done.- Thanks.
0:38:07 > 0:38:09It's a good result for Aki.
0:38:12 > 0:38:16Back at home, the other junior doctors are enjoying some downtime.
0:38:18 > 0:38:20- Oh, no!- Oh, no, Priya!
0:38:22 > 0:38:25- Boom! - Shake hands. Good game.
0:38:28 > 0:38:33But there's no rest for Ben. He has to prepare for his big presentation.
0:38:33 > 0:38:36I was up at about quarter to five this morning.
0:38:36 > 0:38:38Couple of hours work before going in.
0:38:38 > 0:38:41Tired, and hungry, now.
0:38:47 > 0:38:53Today, Ben will present his study at a conference of top paediatric surgeons.
0:38:53 > 0:38:54It's quite a big deal for me.
0:38:54 > 0:38:58Once I'm up on the stage, I'll be absolutely petrified.
0:38:58 > 0:39:00I'll be up there, in front of them,
0:39:00 > 0:39:02having to try and answer questions
0:39:02 > 0:39:05on work that I've done before, so it's all,
0:39:05 > 0:39:07it's exciting for me,
0:39:07 > 0:39:12it's quite a big deal for me, but it's also terrifying.
0:39:17 > 0:39:21Hopefully it'll go not too bad.
0:39:23 > 0:39:25If he succeeds, it will boost his chances
0:39:25 > 0:39:28of clinching his dream job next year.
0:39:28 > 0:39:32If he fails, it could scupper them.
0:39:32 > 0:39:34- You've got too many gaps here. - Oh, yeah.
0:39:34 > 0:39:37- Don't forget to enunciate your words. - Yeah.
0:39:37 > 0:39:40His boss, Mr Clarke, gives him some last-minute advice.
0:39:40 > 0:39:42Just don't feel like you're rushing it, don't worry.
0:39:42 > 0:39:45When you're a bit nervous, sometimes, when you do your first one,
0:39:45 > 0:39:48you tend to speed up, because you just want to get out of here!
0:39:48 > 0:39:51Essentially, the worst thing that could happen is that I stand up on stage
0:39:51 > 0:39:53and look like an absolute fool for seven minutes,
0:39:53 > 0:39:59don't know what I'm talking about, and people ridicule me with questions.
0:39:59 > 0:40:01Ben will have to present the research
0:40:01 > 0:40:05to some of the most respected paediatric surgeons in Europe,
0:40:05 > 0:40:08and Mr Clarke has a front row seat. The pressure is on.
0:40:14 > 0:40:17It's a long wait. Ben's the last on the programme.
0:40:21 > 0:40:25It's his turn. Ben will have to speak for seven minutes.
0:40:31 > 0:40:33Good afternoon. My name's Ben Allin,
0:40:33 > 0:40:35I'm one of the SHOs at Chelsea and Westminster.
0:40:35 > 0:40:38Thank you for giving me the opportunity to talk to you today.
0:40:38 > 0:40:41I briefly want to discuss some work that we've carried out,
0:40:41 > 0:40:43looking at whether laparoscopic inguinal hernia repair
0:40:43 > 0:40:47is comparable to the open approach in a neonatal population.
0:40:47 > 0:40:50Ben is the most junior doctor to present today.
0:40:50 > 0:40:55..making it even more prudent to try and avoid a second operation in this patient population.
0:40:55 > 0:40:57But he pulls it off without a hitch.
0:40:57 > 0:41:01- Thank you very much. - APPLAUSE
0:41:03 > 0:41:05Terrified!
0:41:05 > 0:41:08That was why I was so impressed. You looked extremely composed!
0:41:11 > 0:41:12Thank you very much.
0:41:12 > 0:41:14That was great. Got a really good photograph of you!
0:41:14 > 0:41:18He's probably the most junior person that's stood up today.
0:41:18 > 0:41:21Everybody else are professors, consultants,
0:41:21 > 0:41:24senior registrars from all around Europe.
0:41:24 > 0:41:29He wasn't fazed by any of them, so definitely, he can come back and do it again!
0:41:29 > 0:41:34I think we're going to the pub! I feel like going to the pub.
0:41:34 > 0:41:38It's an impressive achievement for Ben, and a cause to celebrate.
0:41:39 > 0:41:40Hello!
0:41:41 > 0:41:45The end of the junior doctors' placements are fast approaching,
0:41:45 > 0:41:49and back at the house, Milla is hosting a special evening.
0:41:49 > 0:41:52I think this is a really nice way to just celebrate
0:41:52 > 0:41:55the fact that we're coming towards the end of our first rotation.
0:41:55 > 0:41:58I think my housemates are really going to see a side of me
0:41:58 > 0:42:00that they've not seen before.
0:42:00 > 0:42:02I think this party will be totally ridiculous.
0:42:02 > 0:42:05I think all Milla's friends are going to turn up with fur coats.
0:42:05 > 0:42:07Rahs with champagne and swords!
0:42:07 > 0:42:12I've brought a bottle of cava, so we'll see if that cuts the mustard!
0:42:14 > 0:42:19Hello! Hi! I'm very well. Thank you so much for coming.
0:42:19 > 0:42:23- Hello!- How are you? - Fine. I'm very well.
0:42:23 > 0:42:25With the help of a few of her friends,
0:42:25 > 0:42:29Milla's going to introduce all the housemates to the art of sabrage
0:42:29 > 0:42:32- opening champagne bottles with a sword,
0:42:32 > 0:42:34a practice she takes very seriously.
0:42:34 > 0:42:37No, guys, we've got to be really serious about it.
0:42:37 > 0:42:39We're not messing about.
0:42:39 > 0:42:41Woah, we've got a lot of champagne!
0:42:42 > 0:42:46- I know. There's lots of it that needs drinking now.- Right.
0:42:46 > 0:42:48So I think that's the plan.
0:42:48 > 0:42:49Time to begin.
0:42:50 > 0:42:53Ladies and gentlemen. Welcome, everyone.
0:42:53 > 0:42:58A very good friend of mine introduced me to the art a few years ago, and since then,
0:42:58 > 0:43:02I've been initiated to the Confederation of the Golden Sabre.
0:43:02 > 0:43:07I think you'll have a lot of fun, especially if you enjoy champagne as much as I do.
0:43:07 > 0:43:09Are you ready?
0:43:09 > 0:43:12CHEERING
0:43:12 > 0:43:15- Just go across the bottle. - Priya, come on!
0:43:15 > 0:43:18CHEERING
0:43:18 > 0:43:21With long hours and clashing shifts, this is the first time
0:43:21 > 0:43:27since they started that all eight junior doctors have been able to get together at one time.
0:43:27 > 0:43:31We certainly have not been doing enough fun things while we've been working.
0:43:31 > 0:43:34We're all in our twenties, after all,
0:43:34 > 0:43:38and we just have to make the most of life now.
0:43:38 > 0:43:40These are the days that we need to be happy,
0:43:40 > 0:43:43and we need to be enjoying life to its fullest.
0:43:43 > 0:43:48To surviving our first placement! Well done, congratulations.
0:43:55 > 0:44:00# Today I don't feel like doing anything
0:44:00 > 0:44:04# I just wanna lay in my bed. #
0:44:04 > 0:44:07Across the hospital, all the junior doctors are on their last few shifts
0:44:07 > 0:44:11in their current jobs before they move to their new placements.
0:44:13 > 0:44:15Milla's getting stuck in in dermatology.
0:44:15 > 0:44:18Tell him I'll need a syringe.
0:44:18 > 0:44:20Priya is back in surgery.
0:44:22 > 0:44:24Three o'clock, seven o'clock, 11 o'clock.
0:44:24 > 0:44:25Sir?
0:44:25 > 0:44:29For Sameer, it's wake-up time on the stroke unit.
0:44:29 > 0:44:32Sir, I'm going to move your leg. Just let me know if that hurts.
0:44:32 > 0:44:37- Does that hurt?- Ow! God Almighty! Doesn't it hurt!
0:44:37 > 0:44:38Sorry to wake you.
0:44:39 > 0:44:43And in paediatrics, Ben has an important day ahead.
0:44:43 > 0:44:45It's lively around here this afternoon!
0:44:45 > 0:44:50His boss, Mr Clarke, is inviting him to theatre to assist in an operation.
0:44:50 > 0:44:54I'll let you make the incision, and you tell me the layers you're going through as you're doing it,
0:44:54 > 0:44:57and then I will take over at the appropriate moment.
0:44:57 > 0:44:59Fair enough, OK.
0:44:59 > 0:45:03He's giving Ben the chance to make the first incision.
0:45:08 > 0:45:09Nice and shallow. That's fine.
0:45:11 > 0:45:14It's a delicate operation to drain the fluid
0:45:14 > 0:45:18that's gathered around the testicle of a three-year-old boy.
0:45:20 > 0:45:23Mr Clarke allows Ben to continue on his own.
0:45:26 > 0:45:27Not in my direction!
0:45:29 > 0:45:31In your direction, preferably.
0:45:31 > 0:45:35Ben extracts the sack of excess fluid and bursts it like a balloon.
0:45:37 > 0:45:41- Regular?- Just a regular knot, but with a double on one end.- OK.
0:45:41 > 0:45:43Yes, that's it.
0:45:43 > 0:45:46Until now, Ben has only ever assisted in operations.
0:45:47 > 0:45:51- An improvement on eight weeks ago. Well done.- Thank you very much.
0:45:51 > 0:45:56Under Mr Clarke's supervision, he's done most of the operation on his own.
0:45:56 > 0:45:58Have you done that before, explored to the groin?
0:45:58 > 0:46:00No, that's the first time. Thank you very much.
0:46:01 > 0:46:03Quite scary, the first time!
0:46:03 > 0:46:05Nice to be standing on the surgeon's side of the table,
0:46:05 > 0:46:07as opposed to the assistant's side of the table.
0:46:07 > 0:46:10I was just excited to be getting the opportunity to do it.
0:46:10 > 0:46:15It was a bit scary, knowing that he could be expecting me to do bits and pieces,
0:46:15 > 0:46:20and maybe expecting more of me than I can necessarily do, but it was good.
0:46:22 > 0:46:23Go on, jump down.
0:46:25 > 0:46:29When Ben first came to us, like any doctor who arrives on paediatrics,
0:46:29 > 0:46:31is moving into another universe altogether.
0:46:31 > 0:46:34Without doubt, we've watched him grow in confidence.
0:46:34 > 0:46:36Ben is a logical thinker, he's efficient,
0:46:36 > 0:46:38and he works well in a team,
0:46:38 > 0:46:42so I think he's got all the makings of a good surgeon, and I hope
0:46:42 > 0:46:45we've been able to help him along the way over the past few months.
0:46:45 > 0:46:48Do you hear it go ba-boom, ba-boom?
0:46:53 > 0:46:57In general medicine, Lucy's patient Rosemary is leaving.
0:46:57 > 0:47:02- Hello. I'm going home!- I know you are! I know. You look lovely!
0:47:02 > 0:47:07I can't... I want a mirror to put... Do you know where my eyebrows are?
0:47:07 > 0:47:10- Do I know where they are?- Yes. - I think I can probably guess.
0:47:10 > 0:47:13Lucy's worked her way through a tough case,
0:47:13 > 0:47:16and 97-year-old Rosemary is going home happy.
0:47:16 > 0:47:18- I wanted to come and wish you luck. - And you too.
0:47:18 > 0:47:20And say it's been an absolute pleasure looking after you.
0:47:20 > 0:47:22- I've enjoyed it. - I like your personality.
0:47:22 > 0:47:25- Oh, that was very nice of you. Safe journey back.- Thank you.
0:47:25 > 0:47:27Don't have too much fun!
0:47:27 > 0:47:30When somebody says thank you, it makes your day.
0:47:30 > 0:47:31It's hugely important to me that
0:47:31 > 0:47:34I'm doing the right thing by my patients, and for them,
0:47:34 > 0:47:39and getting involved in their care, because at the end of it all,
0:47:39 > 0:47:42you want them to go home well, and you want them to go home happy.
0:47:48 > 0:47:50It's a new beginning for Rosemary.
0:47:50 > 0:47:54But for Lucy, her time on general medicine is coming to an end.
0:47:54 > 0:47:55See you later.
0:47:55 > 0:47:57Lucy has got that special quality about her
0:47:57 > 0:47:58that not only is, you know,
0:47:58 > 0:48:02she's obviously very intelligent, you know,
0:48:02 > 0:48:03about being a doctor itself,
0:48:03 > 0:48:06but she's also very respectful of the people that she's looking after.
0:48:06 > 0:48:09She sees them as a whole, and that's really important.
0:48:09 > 0:48:11I'd rather get the 49 bus.
0:48:11 > 0:48:13Oh, 49 bus?
0:48:13 > 0:48:14I'll be sad to leave here.
0:48:14 > 0:48:17It's been a lovely, lovely first job, but I think when you start to settle into something,
0:48:17 > 0:48:20that's the time to go, particularly when you're a junior doctor,
0:48:20 > 0:48:23because there's more to learn and more to see.
0:48:23 > 0:48:28So, it's been a great first experience. I'll miss it dearly.
0:48:28 > 0:48:31But I think I'm kind of ready for the next thing now.
0:48:37 > 0:48:38See you tomorrow.
0:48:38 > 0:48:41- On the eve of their last shifts. - Hello!
0:48:41 > 0:48:45The junior doctors have an important guest, Sir Peter Rubin,
0:48:45 > 0:48:49from the General Medical Council, who oversees all doctors in the UK.
0:48:51 > 0:48:53I remember what it's like to be a new doctor.
0:48:53 > 0:48:57I graduated in 1974, back in prehistory, when dinosaurs roamed the earth(!)
0:48:57 > 0:49:02He's come to congratulate them on making it through a challenging first few months.
0:49:02 > 0:49:07No matter what preparation you've had or what shadowing you've done,
0:49:07 > 0:49:11there's a real wake-up call when you realise you are THE doctor.
0:49:11 > 0:49:13You'll have some tough learning experiences.
0:49:13 > 0:49:17It does get easier, but you do keep learning, my goodness, you keep learning.
0:49:17 > 0:49:19This is your golden age.
0:49:19 > 0:49:22You'll look back on this time with great fondness.
0:49:22 > 0:49:25The friends you make now will be friends for life,
0:49:25 > 0:49:27and what a privilege that is.
0:49:27 > 0:49:28What a privilege. Thank you, guys, very much.
0:49:28 > 0:49:30APPLAUSE
0:49:38 > 0:49:42Hey, Ben. Are you sad to be leaving your favourite job in the world?
0:49:42 > 0:49:46- It is my favourite job in the world. - I'm excited to wear scrubs tomorrow.
0:49:46 > 0:49:48- You on general surgery?- Yeah.
0:49:48 > 0:49:53Across the hospital, all the junior doctors are finishing their last shifts.
0:49:53 > 0:49:56- Come back and visit! - We will. I'll be back.
0:49:56 > 0:49:59I have never felt so fulfilled
0:49:59 > 0:50:03and so responsible as I have done over the last few months.
0:50:05 > 0:50:08Aki is leaving the Acute Assessment Unit.
0:50:08 > 0:50:10Alison, goodbye.
0:50:10 > 0:50:12Oh, this is sad. We're going to miss you, young man.
0:50:12 > 0:50:15- Thank you, Alison. - I am definitely going to miss Aki.
0:50:15 > 0:50:16He's become part of the team,
0:50:16 > 0:50:18and you do develop working relationships
0:50:18 > 0:50:21with people, and he's been a pleasure to work with, really.
0:50:21 > 0:50:25I won't forget the roots, you know, what made me who I am.
0:50:25 > 0:50:27It's the nurses here on AAU!
0:50:27 > 0:50:31Compared to day one, when I actually thought I was a fraud doctor,
0:50:31 > 0:50:36and I just thought I was an extension of some kind of odd medical student,
0:50:36 > 0:50:41I think, on my last day of AAU, I do feel like I'm a doctor,
0:50:41 > 0:50:45and on my next day off, I'm going to change my credit card to Dr!
0:50:45 > 0:50:50For many, like Lucy, in general medicine, leaving won't be easy.
0:50:50 > 0:50:55- Are you going?! See you! - You've been fantastic.- Thank you.
0:50:55 > 0:50:57- I've really enjoyed it. - It's Lucy's last day today.
0:50:57 > 0:51:02Sorry, I'm quite tearful. I'm quite sad to see her go.
0:51:02 > 0:51:04I hope she realises how good she is,
0:51:04 > 0:51:08and she's just been an amazing member of the team.
0:51:08 > 0:51:09I'm going to miss her.
0:51:11 > 0:51:12Sorry!
0:51:13 > 0:51:16Oh, it's been great. I've loved it.
0:51:16 > 0:51:21- You look really sad.- I am sad!
0:51:21 > 0:51:24- Oh, well.- Right. Go home, everybody. It's late.
0:51:24 > 0:51:26- Take care. I'll see you soon. - Thanks, Kate.
0:51:26 > 0:51:28Oh, you've been lovely!
0:51:29 > 0:51:32I just feel really privileged, actually.
0:51:32 > 0:51:35And, although it's hard work to get here,
0:51:35 > 0:51:38I can't imagine doing anything else with my life.
0:51:45 > 0:51:49It's the end of the first chapter in their medical careers.
0:51:52 > 0:51:57Over the past four months, the junior doctors have learnt how to deal with serious emergencies.
0:51:57 > 0:51:59All right, sweetheart.
0:51:59 > 0:52:01Challenging cases.
0:52:01 > 0:52:03- It's just a question... - No, it's not helpful.
0:52:03 > 0:52:05- Can I just move on to... - No, can you just move back?
0:52:05 > 0:52:07Any pulse?
0:52:07 > 0:52:11They've had to face the harsh reality that they can't save every patient.
0:52:11 > 0:52:15I feel bad, but I don't think there's anything extra we could have done.
0:52:15 > 0:52:19- They've had highs. - I am so happy!
0:52:19 > 0:52:20And lows.
0:52:20 > 0:52:23I'm going to get my colleague to have a go. I'm sorry. I know it's really painful.
0:52:23 > 0:52:26- Just complete- BLEEP,- basically.
0:52:26 > 0:52:28And times they'll never forget.
0:52:28 > 0:52:30Oh, my God. This is the best job ever!
0:52:31 > 0:52:35And they're only at the start of their medical careers.
0:52:44 > 0:52:47Today, all the junior doctors are beginning new jobs.
0:52:49 > 0:52:53They'll move departments every four months to help them build up a variety of skills.
0:52:53 > 0:52:55It feels like I'm going back to school
0:52:55 > 0:52:57every time I start something new in medicine.
0:52:57 > 0:53:01Priya is taking over Aki's role on the Acute Assessment Unit.
0:53:01 > 0:53:04Things seem to be settling down a little bit,
0:53:04 > 0:53:06so we'll try and get you a bit more mobile tomorrow.
0:53:06 > 0:53:10I think the change between when I first started and now is immense.
0:53:10 > 0:53:13I've developed so much in this short span of time,
0:53:13 > 0:53:16and when you look at the old Priya, and look at the current Priya,
0:53:16 > 0:53:22I think now is when I actually am allowed to be called Doctor.
0:53:22 > 0:53:26And Lucy's joining Priya on the Acute Assessment Unit.
0:53:26 > 0:53:28- I walked past the wrong ward. - Did you?
0:53:28 > 0:53:30I was like, "I'm on the wrong ward!"
0:53:32 > 0:53:34It's a change of pace from general medicine.
0:53:34 > 0:53:36All done. Do you want me to prescribe the blood?
0:53:36 > 0:53:40I think this job's going to be quite good for me, because you don't know the patients as well,
0:53:40 > 0:53:43and it's high turnover, and that's the stuff that I find quite difficult,
0:53:43 > 0:53:46so I think that kind of challenge will be good, now.
0:53:46 > 0:53:50- Mr Collier, do you mind if I get scrubbed up?- No, absolutely.
0:53:50 > 0:53:56Sameer is learning how to wield the surgeon's knife in plastic surgery.
0:53:56 > 0:53:58I think you've got your mask on back to front.
0:53:58 > 0:54:01Really? Seriously?
0:54:01 > 0:54:03This is the first time I've been in theatre
0:54:03 > 0:54:07since I've qualified as a doctor, which is quite exciting.
0:54:07 > 0:54:09So many months in,
0:54:09 > 0:54:11it's a bit difficult remembering how to scrub up.
0:54:11 > 0:54:13How have things been going with the chemo?
0:54:13 > 0:54:18- Any problems from it at the moment? - It has worked.- Good news.
0:54:18 > 0:54:23Second year Ben has moved from caring for children to treating adults with cancer.
0:54:23 > 0:54:27There will be times when patients get to you, and it's pretty upsetting.
0:54:27 > 0:54:28Moving on to a new job is always hard,
0:54:28 > 0:54:31and I think it's been even harder this time,
0:54:31 > 0:54:34because I'm moving from a job that I absolutely love,
0:54:34 > 0:54:38a job that I want to do long-term, to one which I'm sure I'll enjoy and will be incredibly useful,
0:54:38 > 0:54:43and it's a great skill to learn, but one that I don't necessarily want to do, long-term.
0:54:43 > 0:54:47Amieth is stepping into the intensive care unit,
0:54:47 > 0:54:50and has made up his mind about where his future lies.
0:54:50 > 0:54:53I've just sent off my application for my next round of jobs,
0:54:53 > 0:54:57which is anaesthetics, and so hopefully, I'll get an offer
0:54:57 > 0:54:59and some interviews and things.
0:54:59 > 0:55:02So, maybe you'll see me in theatres one day,
0:55:02 > 0:55:07just in the anaesthetic room, at the head end of the bed, looking after the patients.
0:55:07 > 0:55:10Hello? I don't really know what cardiology's going to be like.
0:55:10 > 0:55:13- I think it'll be quite interesting. - PAGER BEEPS
0:55:13 > 0:55:14First beep of the day.
0:55:15 > 0:55:17Andy has moved out of surgery...
0:55:17 > 0:55:19Nice big breaths in and out through your mouth.
0:55:19 > 0:55:23..and into medicine, treating patients with heart conditions in cardiology.
0:55:23 > 0:55:26Feel your pulse. Just going to have a listen to your heart.
0:55:26 > 0:55:31I'm always making sure I'm doing the right thing, but I am, now,
0:55:31 > 0:55:35a lot more confident, and I can go into work thinking I know what I'm doing,
0:55:35 > 0:55:38if someone gets ill, I'll be able to deal with it, I think.
0:55:38 > 0:55:41So, yeah, I'm a lot more confident than I was before.
0:55:45 > 0:55:48Aki and Milla are working together,
0:55:48 > 0:55:52and stepping into Andy's old job in general surgery.
0:55:52 > 0:55:56Hello? Hi. My name's Dr Marinova. I'm one of the surgical house officers.
0:55:56 > 0:55:59You're my first surgical patient!
0:55:59 > 0:56:01- I'm honoured!- So am I!
0:56:01 > 0:56:06Fantastic. I might not be doing the life-saving surgery myself,
0:56:06 > 0:56:10but just the fact that you're there, and the little things that you do,
0:56:10 > 0:56:15do actually help, I think just make it the most incredible job in the world.
0:56:15 > 0:56:18This is the letter that the GP will get,
0:56:18 > 0:56:22and this is a copy for you, so you know what's happened.
0:56:22 > 0:56:24I just want to make this year a good one,
0:56:24 > 0:56:30and look back on it and think that I've grown, not just as a doctor, but as a person as well.
0:56:57 > 0:57:00Subtitles by Red Bee Media Ltd